Vertebral fixing system

ABSTRACT

Embodiments disclosed herein provide a method of placing a vertebral fixing system on a vertebra. The vertebral fixing system comprises a connecting part with members forming a space into which a rod may be inserted. The members are moveable relative to each other. A portion of a ligature may be passed through the connecting part to form a loop extending from the connecting part. When the rod is inserted in the space between the members, the ligature may be tensioned against the rod. The members of the connecting part may be driven together to hold the ligature in place. An adjustable locking means may be utilized to fix simultaneously in position the connecting part relative to the rod and at least one portion of the ligature relative to the connecting part, so as to prevent relative displacement of the rod and the vertebra in opposite directions.

CROSS-REFERENCE To RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/248,497, filed Sep. 29, 2011, pending, entitled “VERTEBRAL FIXINGSYSTEM,” which is a continuation of U.S. patent application Ser. No.12/854,753, filed Aug. 11, 2010 now U.S. Pat. No. 8,323,319 entitledVERTEBRAL FIXING SYSTEM, which is a divisional of U.S. patentapplication Ser. No. 12/358,748, filed Jan. 23, 2009, now U.S. Pat. No.7,959,654, entitled “VERTEBRAL FIXING SYSTEM,” which is a continuationof U.S. patent application Ser. No. 10/521,914, filed Jan. 20, 2005, nowU.S. Pat. No. 7,481,828, entitled “VERTEBRAL FIXING SYSTEM,” which is aNational Stage Entry under 35 U.S.C. 371 of :International ApplicationNo. PCT/FR2003/02307, filed Jul. 22, 2003, entitled “VERTEBRAL FIXINGSYSTEM,” which claims priority to French Application No. 02/09317, filedJul. 23, 2002, now U.S. Pat. No. 2,842,724 entitled “SYSTEME DE FIXATIONVERTEBRALE,” all of which are fully incorporated herein by reference.

TECHNICAL FIELD OF THE INVENTION

The present invention relates to a vertebral fixing system adapted to bemounted on a vertebra, and to a spine-straightening assembly using thesystem.

One field of application that is envisaged, is particularly but notexclusively, the treatment of scoliosis or, more generally, thecorrection of abnormal curvatures of the spine.

BACKGROUND OF THE RELATED ART

The spine is formed of superposed vertebrae, normally aligned along avertebral axis, from the lumbar vertebrae to the cervical vertebrae, andeach having a posterior wall from which projects a spinous process andtwo lateral edges from the walls of which there project ribs and/ortransverse processes. If the spine of a person has abnormal curvature,the vertebrae are inclined relative to each other and relative to saidvertebral axis. The lateral edges of the vertebrae on one side aretherefore closer together and form a concave shape while the lateraledges on the other side are farther apart and form a convex shape.

To straighten the vertebral column, the lateral edges of the vertebraeon the concave side are moved away from one another and supported atdistances from one another substantially equivalent to the distancesbetween the lateral edges on the other side. Devices known in the artare used thereafter to hold the vertebrae relative to one another, andcomprise screws that are inserted into the vertebrae or hooks that areinserted along the internal wall of the spinal canal and rods adapted toconnect the screws or hooks.

Pairs of hooks are generally inserted into each vertebra, one on eachside, near the pedicle; they have heads that project from the posteriorwall of the vertebra, one on each side of the spinous process. The headsare tulip-shaped, for example, and are adapted to receive a rod that isimmobilized by a nut that is screwed onto the head and bears on the rod.The heads of the hooks situated on either side of the spinous processare connected together and fixed in position by two rods parallel toeach other and to the axis of the spine.

However, using such hooks is difficult because the operative must notunder any circumstances touch the spinal cord that extends along thecentre of the spinal canal, since that would result in paralysis of thepatient.

Using screws reduces the risks of the procedure. The screws also havetulip-shaped heads and are inserted in pairs into the pedicles on eachside of the spinous process on the posterior wall of the vertebrae. Thescrews therefore constitute fixing points on the vertebrae for holdingthem relative to one another. However, they must be inserted into thepedicles of the vertebrae, which in some cases are small or havedeteriorated.

SUMMARY OF THE INVENTION

A problem that arises, and that the present invention aims to solve, isthat of providing fixing points when it is not possible to insert screwsinto the vertebrae in the abnormal curvature region and when using hooksis too dangerous.

To achieve the above object, a first aspect of the present inventionproposes a vertebral fixing system that comprises: a connecting partadapted to face said rib and/or said transverse process and to beconnected to said rod, an elongate flexible ligature adapted to connecttogether said connecting part and at least one rib and/or one transverseprocess, and adjustable locking means fastened to said connecting partand adapted to fix simultaneously in position said connecting partrelative to said rod and at least one portion of said ligature relativeto said connecting part, so as to prevent relative displacement of saidrod and said vertebra in opposite directions.

Thus, one feature of the invention resides in the method of connectingsaid rod with said vertebrae using the connecting part that connectstogether the flexible ligature and said rod. The ligature, one end ofwhich is connected to said rib and/or transverse process, is adapted tobe immobilized in said connecting part by the adjustable locking means,which also fix said connecting part in position relative to said rod,with the result that relative displacement of said rod and said vertebrais prevented, at least in the opposite direction.

In a first embodiment of the invention, said connecting part includes apassage facing said rod and said ligature passes through the adjustablelocking means to reduce the section of said passage in order to presssaid ligature against said rod and simultaneously to fix said connectingpart and at least one portion of said ligature in position relative tosaid rod.

As a result of this feature of the invention, said ligature is adaptedto be wedged between the wall of the passage in the connecting part andthe wall of said rod and, at the same time, said connecting part isadapted to be fixed in position relative to said rod. As a result, it isonly the action of the adjustable locking means that fixes the ligaturein position and mobilizes the connecting part relative to said rod.

In one particularly advantageous embodiment of the invention, saidligature has a first end fastened to said connecting part and a freesecond end adapted to slide in said connecting part and to be formedinto a loop, a portion of said ligature between said ends being adaptedto be immobilized in translation relative to said connecting part bysaid adjustable locking means, whereby the loop has a particular length.

Thus, the ligature is formed of two sections. One end of the ligature isfixedly clipped to the connecting part, the ligature is then stretchedaround the rib and/or the spinous process, and the free second end ofthe ligature is then inserted into said connecting part. The firstsection of the ligature is the part that extends from the second endinto contact with the rib and/or the transverse process and the secondsection is the part that extends from the rib and/or the transverseprocess to the connecting part. As a result, the free end may bestretched to hold said connecting part against the vertebra, said rodand said ligature being adapted to be locked together by adjustablelocking means.

It is preferable if said connecting part comprises two longitudinalmembers whose first ends are connected together so that said members maypivot relative to each other and the middle parts of their two facingfaces are adapted to bear on respective opposite sides of said rod, saidadjustable locking means being adapted to drive the second ends of saidlongitudinal members forcibly towards each other and to fix them inposition relative to each other so that said two members form a clampand grip said rod, whereby said connecting part may be fixed in positionrelative to said rod.

The two longitudinal members articulated to each other at their firstend form a clamp such that the two middle parts of the two facing facesmay be driven towards each other and grip said rod. The adjustablelocking means hold the two longitudinal members pressed onto saidligature and against said rod.

It is particularly advantageous if said second ends of the twolongitudinal members have, facing each other, a bore in one and a threadin the other, so that a screw may be passed through said bore andscrewed into said thread and form said adjustable locking means.

Turning the screw after it has been passed through the bore and screwedinto the thread therefore forcibly drives the second ends towards eachother. The force immobilizing said connecting part relative to said rodand said ligature is a function of the clamping force applied by saidscrew.

In one particularly advantageous embodiment, said first end of saidligature is fastened to the pivot of said longitudinal members. Thetension force applied to said ligature is therefore substantiallyequally divided between the two first ends of said longitudinal members.

It is preferable if at least one of the middle parts of said two facingfaces has a first portion through which said passage passes and a secondportion adapted to bear against said rod. Accordingly, said secondportion of said longitudinal members of the connecting part is adaptedto bear on and to be in direct contact with said rod whereas the firstportion of the middle parts presses said ligature against said rod. Saidconnecting part is therefore perfectly fastened to said rod and fixed inposition relative to it and at the same time a portion of said ligatureis perfectly wedged between said rod and the wall of said passage.

It is particularly advantageous if said passage extends between twoorifices in said connecting part and opening to the outside of said partso that said ligature is able to slide through said part.

Said ligature is therefore perfectly guided inside said connecting partin said passage with the result that stretching of the free second endof said ligature cannot divert said ligature from said passage,regardless of the driving angle relative to said connecting part. Duringthe stretching of said free end of said ligature, the adjustable lockingmeans immobilize at least a portion of said ligature.

It is preferable if each of said middle parts of said two longitudinalmembers includes an orifice. Said free end of said ligature can then beinserted into one of the two orifices, stretched in the passage thatextends between the two longitudinal members and said rod, and extractedvia the second orifice so that it may be stretched. Pressing the twolongitudinal members against said rod therefore immobilizes the ligatureagainst the rod.

In one particularly advantageous embodiment, said passage has a sectionthat decreases from one orifice to the other so as to be able to exert aprogressive pressure on said ligature portion between said two orificesto press it against said rod.

Thus, according to this feature, the pressure of said ligature on therod may be controlled by the adjustable locking means so that the freesecond end of said ligature may be forcibly stretched, to tension it.Once it has been tensioned, the adjustable locking means may be operatedto immobilize the ligature completely relative to the rod and toimmobilize the connecting part relative to the rod. The loop formedaround the rib and/or the transverse process by said ligature istherefore of fixed size and maintains the tension in said connectingpart facing the posterior wall of said vertebra.

BRIEF DESCRIPTION OF THE DRAWINGS

Other features and advantages of the invention will emerge upon readingthe description given hereinafter and with reference to the appendeddrawings of particular illustrative but non-limiting embodiments of theinvention, in which drawings:

FIG. 1 is a fragmentary diagrammatic perspective view showing avertebral fixing system of the invention and a rod,

FIG. 2 is a diagrammatic view in vertical section of the subject matterof the invention mounted on a rod,

FIG. 3 is a diagrammatic perspective view in section of the subjectmatter of the invention, and

FIG. 4 is a diagrammatic view in elevation of the subject matter of theinvention mounted on a vertebra.

DETAILED DESCRIPTION

FIG. 1 shows a vertebral fixing system of the invention mounted on a rod10. The vertebral fixing system comprises a connecting part 12 havingtwo longitudinal members, of which a first longitudinal member 14extends between a first end 16 and a second end 18 and a secondlongitudinal member 20 extends between a first end 22 and a second end24. The two longitudinal members 14 and 20 are pivoted together at theirfirst ends 16 and 22 for the purposes of mounting the system. The firstend 16 of the longitudinal member 14 has a notch 26 with two oppositeedges 28 and 30 and between which the first end 22 of the otherlongitudinal member 20 may be inserted. A pivot pin 32 passes throughthe two first ends 16 and 22 and is free to rotate in at least one ofsaid ends 16 and/or 22, The second end 18 of the first longitudinalmember 14 includes a bore 34 into which a screw 36 may be inserted. Thesecond end 24 of the second longitudinal member 20 comprises a thread 38which is aligned with said bore 34 when the two longitudinal members aredisposed facing each other, with the result that the screw 36 may bescrewed into said thread 38 in order to drive the second ends 18 and 24of the two longitudinal members 14 and 20 towards each other. Theconsequences of screwing said screw 36 into the thread 38, therebyforming the adjustable locking means, are explained in more detailhereinafter. FIG. 1 also shows a first orifice 40 through which aligature may be stretched. The method of connecting said ligature tosaid connecting part is described with reference to FIG. 2.

FIG. 2 shows again the connecting part 12 consisting of the firstlongitudinal member 14 and the second longitudinal member 20, saidlongitudinal members 14 and 20 pivoting about the pin 32 that joinsthem. The adjustable locking means consisting of said screws 36 passingthrough the bore 34 and screwed into the thread 38 immobilize saidconnecting part 12 relative to the rod 10 and fix in position a portionof a ligature 42 shown in part in FIG. 2.

The ligature 42 consists of an elongate flexible member capable ofconforming to the contour of the parts that it must connect.

The ligature 42 has a first end 44 that is ligated around the pin 32 anda free second end 46 that is inserted into a passage 48 between the rod10 and the internal walls 50 and 52 of the longitudinal members 14 and20 and the external wall of the rod 10. As shown in FIG. 2, the secondlongitudinal end 20 includes a second orifice 54 through which saidligature 42 passes. Moreover, as shown in FIG. 4, the ligature 42 may beformed into a loop 56 in which the transverse process is trapped.Clearly, where applicable, the ligature 42 may also trap the rib.

As shown in FIG. 3, which shows again the second longitudinal member 20,the middle part has a first portion 56 through which said passage 48passes and a second portion 58 adapted to bear directly on the rod.Accordingly, the passage 48, which is symmetrical inside the firstlongitudinal member 14, is produced by a groove formed in each of thetwo facing faces of the middle parts of the longitudinal members 14 and20.

It is clear in FIG. 3 that the first portion 58 of the middle part formsan edge with cylindrical symmetry and that the corresponding secondportion of the middle part of the first longitudinal member 14 forms asubstantially cylindrical space 60 into which said rod 10 is inserted.

FIG. 2 shows that the second portion 58 of the middle part comes intocontact with the rod and is adapted to bear on top of it and the firstportion 56 presses the free second end of said ligature 42 against therod 10. The adjustable locking means therefore drive the longitudinalmembers 14 and 20 forcibly against the rod 10 and simultaneously againstthe ligature 42, which is also forcibly pressed against the rod 10.

It is particularly advantageous if, as shown in FIG. 2, the passage 48has a section S1 in the vicinity of the orifice 54 greater than thesection S2 in the vicinity of the first orifice 40, the section of saidpassage 48 decreasing progressively in the direction from the secondorifice 54 to the first orifice 40. The ligature 42 is thereforeprogressively compressed around a portion of the rod 10 with a pressurethat increases in the direction from the second orifice 54 towards thefirst orifice 40.

FIG. 4 shows a vertebral fixing system of the invention mounted on avertebra having a transverse process. This figure shows again the rod 10and the two longitudinal members 14 and 20 that grip it and press aportion of the ligature 42 against said rod 10.

in FIG. 4, the flexible ligature 42 consists of a flexible strip ofsubstantially constant width and thickness whose first end is ligated tothe pin 32, the ligature surrounding the transverse process of thevertebra being inserted through the connecting part 12. The section ofthe flexible strip 42 is substantially rectangular so that, the pin 32and the rod 10 being substantially perpendicular to the transverseprocess, the ligature has to be partly twisted in order to insert itinto the passage 48 and between the ligature 32 and the point at whichit contacts the transverse process. The fixing system 12 is fixed inposition against the posterior wall 60 of the vertebra despite thesepartially twisted portions, the ligature 42 being forcibly tensioned bystretching the free second end 46.

The ligature 42 is advantageously made from a flexible material such aspolyester that may be lightly crushed locally to immobilize it with aclamping effect.

A second aspect of the invention relates to a spine straighteningassembly comprising a plurality of vertebral fixing systems conformingto the present invention and mounted on a plurality of successivevertebrae, on all the transverse processes of one lateral wall thereof,and connected to a single rod that is disposed substantially parallel tosaid spine. The transverse processes of a portion of the spine cantherefore be connected together by a single longitudinal rod, to fixthem in position relative to each other, by means of the above vertebralfixing system.

What is claimed is:
 1. A fixation assembly comprising: a connecting rod;a flexible ligature comprising a first end and a second end; a bodycomprising a receiver space shaped to receive the connecting rod and atleast a portion of the flexible ligature, the body including a firstorifice and a second orifice disposed therein, the first orifice and thesecond orifice positioned to route the first end of the flexibleligature through the body and around a portion of the connecting rodwithin the receiver space, wherein the body further comprises a fixationpoint to terminate the second end of the flexible ligature; and athreaded fastener configured to engage the body to secure the connectingrod and flexible ligature against at least a portion of an inner surfaceof the receiver space.
 2. The fixation assembly of claim 1, wherein thebody comprises a first arm and a second arm that cooperate to form thereceiver space.
 3. The fixation assembly of claim 2, wherein the firstorifice is disposed in the first arm and the second orifice is disposedin the second arm.
 4. The fixation assembly of claim 3, wherein thethreaded fastener engages at least a portion of the first arm and thesecond arm.
 5. The fixation assembly of claim 4, wherein at least one ofthe first arm and the second arm comprises a threaded portion to engagethe threaded fastener.
 6. The fixation assembly of claim 2, wherein thefirst arm and the second arm are hinged.
 7. The fixation assembly ofclaim 1, wherein the flexible ligature forms a loop with the first endrouted through the first orifice and the second orifice and the secondend fixed to the fixation point.
 8. The fixation assembly of claim 1,wherein the wherein the threaded fastener does not directly contact theflexible ligature.
 9. A fixation assembly comprising: a connecting rod;a flexible ligature comprising a first end and a second end; a bodycomprising a receiver space shaped to receive the connecting rod and atleast a portion of the flexible ligature, the body including a firstorifice and a second orifice disposed therein, the first orifice and thesecond orifice positioned to route the first end of the flexibleligature through the body and around a portion of the connecting rodwithin the receiver space; and a threaded fastener configured to engagethe body to secure the connecting rod and flexible ligature against atleast a portion of an inner surface of the receiver space.
 10. Thefixation assembly of claim 9, wherein the body further comprises afixation point to terminate the second end of the flexible ligature. 11.The fixation assembly of claim 10, wherein the flexible ligature forms aloop with the first end routed through the first orifice and the secondorifice and the second end fixed to the fixation point.
 12. The fixationassembly of claim 9, wherein the body comprises a first arm and a secondarm that cooperate to form the receiver space.
 13. The fixation assemblyof claim 13, wherein the first orifice is disposed in the first arm andthe second orifice is disposed in the second arm.
 14. The fixationassembly of claim 14, wherein the threaded fastener engages at least aportion of the first arm and the second arm.
 15. The fixation assemblyof claim 15, wherein at least one of the first arm and the second armcomprises a threaded portion to engage the threaded fastener.
 16. Thefixation assembly of claim 12, wherein the first arm and the second armare hinged.
 17. The fixation assembly of claim 9, wherein the threadedfastener does not directly contact the flexible ligature.
 18. Thefixation assembly of claim 9, wherein the threaded fastener does notdirectly contact the connecting rod.
 19. The fixation assembly of claim9, wherein engaging the threaded fastener with the body secures theconnecting rod from movement within the receiver space.
 20. The fixationassembly of claim 9, wherein engaging the threaded fastener with thebody compresses the flexible ligature between the connecting rod and asurface of the receiver space.
 21. An apparatus comprising: an elongatemember; a flexible ligature; a body comprising a first arm and a secondarm that cooperate to form a center recess to receive the elongatemember and at least a portion of the flexible ligature, the first armincluding a first orifice disposed therein and the second arm includinga second orifice disposed therein, the first orifice and the secondorifice positioned to route a first end of the flexible ligature arounda portion of the connecting rod within the center recess; and a threadedfastener configured to engage at least a portion of each of the firstarm and the second arm to secure the elongate member and flexibleligature against at least a portion of an inner surface of the centerrecess.
 22. The apparatus of claim 21, wherein the body furthercomprises a fixation point to receive a second end of the flexibleligature, and wherein a middle portion of the flexible ligature createsa loop when the second end is secured to the fixation point and thefirst end is routed through the body.